[Medication reconciliation on admission: One year of practice in health care institutions during the COVID-19 pandemic]

OBJECTIVES

Medication reconciliation is a key point of the v2020 certification. The main objective of this study was to evaluate this activity over one year, including the first epidemic wave at COVID-19. The secondary objectives were to identify the obstacles and levers and to evaluate doctor satisfaction.

METHODS

This was a retrospective study of drug reconciliations performed on admission during 12 months of the emergence of COVID-19. Patients aged 65 years and older from orthopedic and visceral surgery, acute hospitalization and conventional medicine units were included. Unintentional discrepancies were analyzed. The obstacles and levers were identified by means of a focus group. Doctors' satisfaction was collected using online quiz.

RESULTS

A total of 760 patients were conciliated, of which 27% (n=208) by hospital pharmacy technicians. A decrease in activity was observed during the first epidemic wave. An unintentional discrepancy was found in 77% of patients, and only 48% were corrected by the prescriber. These results were impacted by the pandemic. The pharmaceutical team was mobilized in the logistical management of the crisis, but it was able to adapt in order to perpetuate the activity. Doctors are satisfied with the process.

CONCLUSIONS

Medication reconciliation on admission is essential for the prevention of iatrogeny, particularly with the impact of the COVID-19 pandemic in healthcare institutions.

Prediction of the Long-Term Performance of an Existing Warm Recycled Motorway Pavement

Warm mix asphalt (WMA) technologies allow the production, lay-down and compaction of asphalt mixtures at reduced temperatures and the use of higher amounts of reclaimed asphalt pavement (RAP) with respect to conventional hot mix asphalt (HMA), leading to significant environmental benefits and energy savings. However, limited data is available on the long-term performance of such pavements. The objective of this study was to predict the long-term performance of an existing warm recycled motorway pavement (made with WMA mixtures containing RAP) constructed in 2016 in central Italy, along with the corresponding hot recycled pavement (made with HMA mixtures containing RAP). For this purpose, cores were taken from the pavements in 2022 to investigate the binder and base courses through dynamic modulus and cyclic fatigue tests, according to the simplified viscoelastic continuum damage (S-VECD) testing approach. The results of the tests were used to predict the service life of the pavements using two pieces of software, KENPAVE and FlexPAVE, based respectively on the elastic design method and the viscoelastic design method in the presence of damage. The FlexPAVE results indicated that the expected service life of the WMA pavement is much longer than that of the HMA pavement, mainly because the WMA mixtures have better damage properties than the HMA mixtures. Conversely, the KENPAVE simulations predicted a similar service life for the two pavements, highlighting the impossibility of the elastic method to catch the actual contribution of high-performance non-standard materials. The promising outcomes of the FlexPAVE simulations further encourage the application of warm recycled pavements.

Influence of Geocomposite Properties on the Crack Propagation and Interlayer Bonding of Asphalt Pavements

The application of geocomposites as reinforcement in asphalt pavements is a promising solution for the maintenance/rehabilitation of existing pavements and for the construction of new pavements, whose effectiveness strongly depends on the physical and mechanical properties of the geocomposite. This study aims at assessing the influence of four different geocomposites, obtained by combining a reinforcing geosynthetic with a bituminous membrane, on the crack propagation and interlayer bonding of asphalt pavements. First, a laboratory investigation was carried out on double-layered asphalt specimens. The crack propagation resistance under static and dynamic loads was investigated through three-point bending tests (carried out on specimens with and without notch) and reflective cracking tests respectively, whereas the interlayer shear strength was evaluated through Leutner tests. Then, a trial section was constructed along an Italian motorway and a Falling Weight Deflectometer (FWD) testing campaign was carried out. The laboratory investigation highlighted that—as compared to the unreinforced system—the geocomposites increased the crack propagation energy in the layer above the reinforcement from five to ten times, indicating that they can significantly extend the service life of the pavement by delaying bottom-up and reflective cracking. However, they also worsened the interlayer bonding between the asphalt layers (de-bonding effect). The field investigation indicated that all geocomposites decreased the stiffness of the asphalt layers with respect to the unreinforced pavement as a consequence of the de-bonding effect, thus corroborating the laboratory results. Based on the results obtained, it is desirable that the geocomposite possess a high energy dissipation capability and an upper coating ensuring good adhesion between the asphalt layers. The monitoring of the existing trial section in the future will provide useful data on the long-term field performance of reinforced pavements subjected to actual motorway traffic.

Basal insulin therapy is associated with beneficial effects on postoperative infective complications, independently from circulating glucose levels in patients admitted for cardiac surgery

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The effect of insulin per se on infective complications during cardiac surgery was evaluated.

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Eight hundred twelve patients were included.

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Insulin therapy decreased infections independently from glycemic levels.

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Basal + premeal insulin therapy is well tolerated without severe hypoglycemia cases.

Background

Although hyperglycemia is a strong predictor of postoperative infective complications (PIC), little is known about the effect of basal insulin therapy (BIT) per se on PIC.

Aim

To evaluate if there is an association between BIT, independent of glucose levels, and a possible improvement of PIC during the perioperative cardiosurgery period (PCP).

Methods

In 812 patients admitted for cardiac intervention and treated with a continuous intravenous insulin infusion (CIII) for hyperglycemic levels (>130 mg/dl), a retrospective analysis was performed during the PCP (January 2009–December 2011). Upon transfer to the cardiac surgery division, if fasting glucose was ≥130 mg/dl, a basal + premeal insulin therapy was initiated (121 patients, group 1); for <130 mg/dl, a premeal insulin alone was initiated (691 patients, group 2).

Findings

Compared with group 2, group 1 showed reductions in PIC (2.48% vs 7.96%, p < 0.049; odds ratio: 0.294; 95% CI: 0.110–0.780), C-Reactive Protein (p < 0.05) and white blood cell (p < 0.05) levels despite glucose levels and CIII that were higher during the first two days after surgery (179.8 ± 25.3 vs 169.5 ± 10.6 mg/dl, p < 0.01; 0.046 ± 0.008 vs 0.037 ± 0.015 U/kg/h, p < 0.05, respectively). Normal glucose levels were achieved in both groups from day 3 before the discharge. The mean length of hospital duration was 18% lower in group 1 than in group 2 (7.21 ± 05.08 vs 8.76 ± 9.08 days, p < 0.007), providing a significant impact on public health costs.

Conclusions

Basal + preprandial insulin therapy was associated with a lower frequency of PIC than preprandial insulin therapy alone, suggesting a beneficial effect of basal insulin therapy on post-surgery outcome.

[Nasal administration of fentanyl: prevention of medication-related errors by using REMED-method]

REMED stands for a "MEDication Errors Review". The REMED method aims at implementing and monitoring actions to improve patient medical care. This approach is part of the continuing healthcare quality and safety improvement and professional practice evaluation. REMED uses methodology and tools. Thus we use this methodology in the context of a drug errorwhich occurred in the dermatology department of our hospital. After this event description, related to a sensitive drug product, Instanyl (transmucosal fentanyl), the drug error is described, then the different causes are analyzed. These last are numerous and occur at any stage of patient medical care. They must allow us to show actions in order to improve patients' safety.

[FAV-Africa: a polyvalent antivenom serum used in Africa and Europe]

FAV-Afrique is a polyvalent snake antivenom, elaborated by immunisation of horses with venom from 10 different snake species among the most dangerous in Africa and belonging to Elapidae and Viperidea families. Only F(ab')2 fragments are kept and purified. This serum is able to decrease the quantity of circulating venom and therefore its toxicity. Its use is indicated as soon as the first signs of poisoning are observed (local oedema). Twenty millimetres are administrated via intra-venous route whatever the weight of the patient. Re-administration may be performed if improvement is not sufficient. Treatment should be initiated as soon as possible but can be realized as long as the symptoms are present. Side effects (allergy) should be considered but balanced with the seriousness of poisoning. There is no absolute contraindication or drug interaction reported with FAV-Africa. It is authorized and distributed in several African countries and has a temporary regulatory approval in France. The major limits to its use are high cost and storage conditions (maximum 36 months between +2 degrees C and +8 degrees C). In the future, the new serum Antivipmyn Africa, available as a freeze-dried product, which can be preserved at room temperature, should improve storage conditions and availability of treatment, especially in rural Africa.

[Lethal aortic endocarditis due to Gemella morbillorum in a Djiboutian khat user]

We report a 22-year-old man who presented in January 2009 in Djibouti for an aortic-abscessed endocarditis due to Gemella morbillorum (G. morbillorum). A voluminous aortic abscess that extended to the perimembranous ventricular septum was fistulized into the right atrium. Atrioventricular conduction abnormalities were observed. The portal of entry was dental with multiples caries and a periodontitis attributed to khat chewing. The patient died within few days. Diagnosis, severity and management of endocarditis due to this rare bacterium are discussed.

Polygalacturonase-inhibiting protein interacts with pectin through a binding site formed by four clustered residues of arginine and lysine

Polygalacturonase-inhibiting protein (PGIP) is a cell wall protein that inhibits fungal polygalacturonases (PGs) and retards the invasion of plant tissues by phytopathogenic fungi. Here, we report the interaction of two PGIP isoforms from Phaseolus vulgaris (PvPGIP1 and PvPGIP2) with both polygalacturonic acid and cell wall fractions containing uronic acids. We identify in the three-dimensional structure of PvPGIP2 a motif of four clustered arginine and lysine residues (R183, R206, K230, and R252) responsible for this binding. The four residues were mutated and the protein variants were expressed in Pichia pastoris. The ability of both wild-type and mutated proteins to bind pectins was investigated by affinity chromatography. Single mutations impaired the binding and double mutations abolished the interaction, thus indicating that the four clustered residues form the pectin-binding site. Remarkably, the binding of PGIP to pectin is displaced in vitro by PGs, suggesting that PGIP interacts with pectin and PGs through overlapping although not identical regions. The specific interaction of PGIP with polygalacturonic acid may be strategic to protect pectins from the degrading activity of fungal PGs.

C(6)-Oxidation Followed by C(5)-Epimerization of Guar Gum Studied by High Field NMR

Guar gum, a beta-D-(1-->4)-linked D-mannan with alpha-D-galactopyranosyl units attached as side groups, was treated with alpha-galactosidase, an enzyme that splits off the alpha-D-galactosyl units to obtain a galactomannan with a low galactose content. The galactose-depleted polysaccharide was then selectively oxidized in C(6) position and epimerized using mannuronan C(5)-epimerases, namely AlgE1, AlgE4, AlgE6, and their mixtures, obtaining new pseudo-alginates. In this paper, we report a full high field 1D and 2D NMR study of guar gum as such and of the galactose-depleted, oxidized and epimerized compounds, respectively. From the 1H NMR spectra, the degree of epimerization, the distribution of mannuronic acid (M) and guluronic acid (G) residues and the average G-block length, N(G>1), were obtained. By means of NMR diffusion experiments, it was also shown that no significant degradation of the polysaccharide occurs as a consequence of the epimerization reactions.

Effects of supplementation with unsaturated fatty acids on plasma and membrane lipid composition and platelet function in patients with cirrhosis and defective aggregation

BACKGROUND/AIMS

Defective platelet aggregation and reduced platelet production of thromboxane A2, a metabolite of arachidonic acid, are common findings in patients with cirrhosis. We evaluated the effects of dietary supplementation with two combinations of unsaturated fatty acids on platelet function and plasma and membrane fatty acids in patients with liver cirrhosis.

METHODS

In a double-blind study, 15 patients with cirrhosis and defective aggregation were randomized to receive a 6-week supplementation with gamma-linolenic and linoleic acid (1 g/day of each fatty acid) or with oleic acid and linoleic acid (groups GLA and OA, respectively).

RESULTS

Under baseline conditions, patients showed elevated concentrations of monounsaturated fatty acids and a reduction in polyunsaturated fatty acids. The product/precursor ratios for delta6 and delta5 desaturases, two key enzymes in the pathway leading to arachidonic acid, were significantly reduced in the group of patients. In the GLA group, a significant increase in the levels of dihomo-gamma-linolenic acid (20:3omega6) was observed in plasma and membranes, together with a parallel decrease in the 20:4/20:3omega6 ratio after supplementation. No significant changes were observed in the OA group. The levels of arachidonic acid did not change significantly in either group of patients. Platelet aggregation to collagen was unchanged in the GLA group, but significantly improved in the OA group.

CONCLUSIONS

These results show that supplementation with precursors of arachidonic acid is ineffective in elevating plasma or membrane arachidonate levels and does not improve platelet aggregation, suggesting that synthesis of arachidonic acid through the delta5 desaturase cannot be correspondingly activated or that incorporation/retention of the produced fatty acid into lipids is impaired. The increased platelet aggregation in the OA group is likely to be explained by the effect of oleic acid contained in the diet, the effects of which may have been counteracted by the elevation in 20:3omega6, a source of anti-aggregatory prostanoids, in the GLA group.

[Chromium binding to leukocytes]

The experiment has been done on 63 patients affected by allergic contact dermatitis and sensitized to potassium dichromate and on 76 non allergic subjects to control: if leukocytes (separated in emagel), mononuclear cells (separated in lymphoprep) and T-lymphocytes (separated through rosettes with neuraminidase) bind the 51Cr, if this binding depends on the valence (Cr3+ and Cr6+) and on the type of cells and if it is conditioned by the hypersensitivity. Through incubation of the cells with the tracing at 4 degrees C and in different times, it has been demonstrated that the binding takes place, it depends on the valence and, in certain conditions it is bigger for the mononuclear cells and the T-lymphocytes in allergic subjects.